A deviated septum can narrow the nasal cavity and obstruct airflow, thus increasing the burden on breathing during sleep. While this is not a direct cause of sleep apnea, it increases the risk of it or worsens existing symptoms.
Deviated Septum And Sleep Apnea
If a person breathes through their mouth for an extended period while asleep, it triggers a reflex mechanism that narrows the airway in the throat from two sides. Once the airway space is reduced, it can easily lead to snoring or even sleep apnea.
Opening your mouth during sleep primarily triggers snoring and sleep apnea in two ways:
First, when the mouth is open, the jaw naturally moves backward and downward, causing the base of the tongue to retract, directly compressing and narrowing the airway in the throat.
Second, opening the mouth during sleep causes the throat muscles to relax, making it unable to effectively open the airway. In this situation, if one still attempts to breathe through the narrow nasal cavity, the forceful inhalation creates a strong “inward pulling” effect.
This makes the already narrow and unsupported airway extremely prone to collapse and blockage, preventing airflow and resulting in sleep apnea.
The prevalence of nasal stenosis supports this view. Many people with sleep apnea also have nasal stenosis due to a deviated septum.
Unlike the throat, the nose itself doesn’t “collapse” and become blocked, so simple nasal congestion usually doesn’t directly cause apnea.
However, a deviated septum can indirectly worsen sleep apnea—it forces patients to breathe through their mouths, increasing the risk of airway collapse.
Therefore, correcting a deviated septum and clearing the nasal passages not only improves nighttime ventilation but also eliminates the trigger for forced mouth breathing, effectively preventing airway collapse and reducing the probability of sleep apnea.
The relationship between a deviated nasal septum and sleep apnea syndrome is as follows:
1. Indirect association: A simple deviated nasal septum rarely causes sleep apnea on its own, but it is often combined with factors such as obesity and a receding chin, significantly increasing the risk of upper airway obstruction.
Studies show that approximately 30% of patients with severe deviated nasal septum may also have obstructive sleep apnea.
2. Superimposed Symptoms: Severe nasal congestion can cause restless sleep throughout the night, with repeated awakenings and gasps for air. This not only easily masks the true cause but can also worsen snoring and sleep apnea.
Therefore, many patients experience relief from sleep apnea after addressing their deviated septum and restoring nasal patency.
3. Individual Differences: The degree and location of the deviation, as well as an individual’s underlying physical condition, can lead to significant individual differences.
For example, a deviation located in the upper part of the nasal cavity often has a greater impact on ventilation. For people who already suffer from allergic rhinitis, the combination of these factors can more easily worsen symptoms.
Symptoms of A Deviated Septum
The nasal septum, the bony cartilage separating the left and right nasal cavities, can become bent or deformed due to development or trauma.
Its main symptoms include persistent nasal congestion, recurrent nosebleeds, headaches, facial pain, and a decreased sense of smell. If left untreated, it can not only affect breathing but also potentially impact sinus health or disrupt sleep quality.
1. Persistent Nasal Congestion
This is the most common symptom. Most patients experience prolonged nasal congestion, which may always be on one side or, due to structural abnormalities, may cause alternating congestion on both sides.
The congestion is significantly worse during a cold or acute rhinitis flare-up.
2. Recurrent Small Nosebleeds
The mucous membrane at the deviated nasal protrusion is thinner, and the blood vessels are more superficial, making it easily damaged by dry air or slight touch (such as picking the nose). This type of bleeding is usually small in amount but frequent.
3. Headache and Facial Distending Pain
The deviated area compresses the lateral wall of the nasal cavity, which may irritate nerve endings, causing dull or distending pain in the forehead, eye socket, or face on one side.
The intensity of the pain often increases with worsening nasal congestion and is more pronounced when the body is fatigued or when bending over.
4. Reduced Sense of Smell
Long-term severe nasal congestion or chronic inflammation prevents airflow from reaching the olfactory region, leading to a decreased ability to distinguish smells.
This condition is usually temporary, and the sense of smell usually recovers once the nasal congestion subsides or the inflammation resolves.
A deviated nasal septum can also be accompanied by other symptoms:
1. Increased nasal discharge or postnasal drip: Due to the structural abnormality, secretions cannot drain properly, easily leading to rhinitis or sinusitis. This manifests as increased thick nasal discharge or a feeling of nasal discharge flowing back into the throat.
2. Snoring and sleep apnea: Severe nasal congestion forces mouth breathing at night, easily causing loud snoring. If ventilation is insufficient for a long time, it may also lead to sleep apnea due to hypoxia.
3. Ear fullness or tinnitus: If the inflammation involves the nasopharynx or affects the function of the Eustachian tube, a feeling of blockage in the ear, buzzing, or even temporary hearing loss may occur.
What Causes a Deviated Septum?
The main causes of a deviated septum include congenital developmental abnormalities, trauma or external force, nasal cavity diseases, and degenerative changes.
These factors, alone or in combination, may cause the nasal septum cartilage or bone structure to deviate from the midline, leading to symptoms such as nasal congestion and headaches.
1. Congenital Developmental Abnormalities
The nasal septum is composed of bone and cartilage. If the growth rates of these two components are out of sync during childhood or adolescence—for example, if the cartilage grows faster than the bone—compression and deformation can occur within the limited space.
Furthermore, some individuals are born with a poorly shaped nasal septum, which may gradually develop into a significant deviation in adulthood.
2. Trauma or External Force
The causes of nasal septum deviation are diverse, mainly falling into two categories: developmental abnormalities and external forces.
During fetal development or puberty, if the growth rates of the nasal septum cartilage and bone do not match, curvature may occur due to insufficient space.
Some individuals are born with morphological abnormalities that gradually become apparent with age.
In addition, acute trauma such as sports impacts or falls can directly lead to cartilage or bone fractures and misalignments. Seemingly minor bumps or knocks in childhood, if left uncorrected, can amplify the deformity during growth.
It is worth noting that bad habits such as prolonged nose picking or excessive nose blowing can also subtly alter the shape of the nasal septum due to continuous mechanical stimulation.
3. Nasal Cavity Lesions
Certain internal nasal diseases can also contribute. When polyps or tumors grow in the nasal cavity, or when there is chronic severe rhinitis or sinusitis, it can continuously compress the nasal septum, forcing it to gradually deviate from its central position.
Furthermore, long-term unilateral nasal congestion caused by conditions such as adenoid hypertrophy in children can create asymmetrical pressure due to unbalanced airflow on both sides of the nose, which may indirectly induce or worsen septal deviation over time.
4. Degenerative Changes
In older adults, age-related degeneration, such as decreased cartilage elasticity and bone resorption, can gradually lead to nasal septal deviation. This type of deviation usually progresses slowly and may contribute to symptoms along with nasal mucosal atrophy.
5. Other Influencing Factors
Statistics show that men have a slightly higher incidence rate than women due to their facial bone structure and a higher probability of trauma. A genetic predisposition in some families also makes certain members more susceptible to developmental abnormalities.
On the other hand, improper nasal or sinus surgeries that damage the supporting structures of the nasal septum can also lead to secondary deviation post-surgery.
How Deviated Septum Affect Breathing?
Nasal airflow is crucial for proper breathing, as anything that narrows the airway can lead to breathing problems. People with nasal congestion often sleep with their mouths open, a reflex that can cause sleep apnea, including snoring and sleep apnea.
In addition, nasal breathing has two unique characteristics that distinguish it from mouth breathing:
First, the nose acts as a heating element. You may notice that if you breathe through your mouth, your mouth and throat become very dry. However, the air passing through the nose is slightly warmer and reaches the lungs at a more comfortable temperature for the body.
Second, the nose filters dust particles and other pollutants inhaled from the air. Furthermore, the nose contains special sensors that transmit information about the airflow through it to the respiratory center in the brain.
Using these sensors, the nose actively participates in controlling and managing breathing. Without these sensors, we wouldn’t be able to know how much air has entered our lungs accurately.
The nasal septum is the cartilaginous structure that separates the left and right nasal cavities. Significant deviation can lead to the following problems:
1. Nasal cavity narrowing: The deviated septum compresses one side of the nasal cavity, reducing airflow and obstructing breathing.
2. Breathing difficulties: A deviated septum can cause nasal cavity narrowing, increasing resistance to airflow, and leading to breathing difficulties and other discomfort.
3. Mucosal irritation: The deviated septum may repeatedly rub against the nasal turbinates, causing chronic inflammation or edema, further worsening obstruction.
4. Olfactory dysfunction: A deviated septum can affect the flow of nasal secretions, causing mucus buildup, which in turn affects the function of receptors in the nasal mucosa, even leading to olfactory dysfunction.
5. Nasal bleeding: Direct airflow into the deviated septum, or even contact with fingers, can easily damage it, potentially causing nasal bleeding.
6. Nasal congestion and headache: Due to a deviated nasal septum, nasal congestion occurs on the deviated side. As the condition progresses, the nasal mucosa on the other side may undergo compensatory thickening, leading to bilateral nasal congestion.
Furthermore, the bony ridge can irritate the inferior or middle turbinate, causing reflex headaches.
7. Inflammation: A deviated nasal septum may obstruct sinus drainage, leading to rhinitis, sinusitis, or fungal rhinitis.
8. Compensatory mouth breathing: Chronic nasal congestion may cause people to breathe through their mouths habitually, and the tongue may fall back during sleep, increasing the risk of upper airway collapse.
Deviated Septum Intervention and Treatment
We need to assess the degree of nasal septum deviation. If accompanied by persistent nasal congestion, recurrent nosebleeds, headache, or a confirmed diagnosis of OSAHS, medical attention is recommended.
The degree of deviation will be determined through nasal endoscopy and CT scans, and the severity of sleep apnea will be assessed using polysomnography (PSG).
A deviated septum can be treated through conservative observation, septoplasty, medication, physical therapy, etc.
1. Conservative observation
Mild septal deviation without obvious symptoms can be left untreated, with regular nasal checkups. Avoid forceful nose blowing or picking to prevent mucosal damage.
If you also have allergic rhinitis, reduce exposure to allergens such as pollen and dust mites.
2. Septoplasty
This surgery is indicated for conditions such as persistent nasal obstruction and sleep apnea caused by severe septal deviation.
The procedure involves removing some of the deviated cartilage and bone to restore nasal ventilation. Postoperative hemostatic packing is required for 1-2 days.
This condition may be related to congenital developmental abnormalities or post-traumatic healing malformations and is often accompanied by turbinate hypertrophy.
A modified cartilage-preserving procedure can be used for adolescents to correct the deviation by reshaping the cartilage. This procedure reduces blood loss and the risk of perforation, making it suitable for patients with chronic sinusitis.
Temporary hyposmia may occur after surgery, but it typically resolves within 1-3 months.
3. Drug treatment
For secondary symptoms, budesonide nasal spray can be used short-term to reduce mucosal edema, and physiological seawater nasal spray can be used to keep the nasal cavity moist.
4. Physical therapy
Nasal irrigation can clear secretions and improve ventilation. Low-frequency pulsed electromagnetic field therapy can help relieve neuralgic headaches caused by deflection and compression.
However, this method cannot change the deflection of the bony structure and is intended only as an adjunct.
Patients with right nasal septum deviation should maintain indoor humidity at 40%-60%, and wear masks when going out in winter to reduce cold air stimulation.
